Home Health Care Medicare Maximization Services
New York > Office of the Medicaid Inspector General > Division of Medicaid Audit > Bureau of Provider Audit
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Submission Instructions
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Description
The New York State Office of the Medicaid Inspector General is seeking one contractor to operate its Home Health Care Medicare Maximization program. The scope includes claims analysis and case selection; medical and legal reviews; pursuing Medicare coverage through all available administrative appeal levels; coordinating with home health providers, Medicare contractors, CMS, and other stakeholders; supporting audits, recoveries, reconciliation, provider compliance, and expert testimony; preparing operational and financial reports; providing provider education; and maintaining systems, records, a toll-free assistance line, and dedicated email support. Covered services include skilled nursing, home health aide, physical therapy, occupational therapy, speech-language pathology, and medical social services. The contractor must support approximately 1,700 appeal cases annually, potentially more than 100,000 claims annually, and changing Medicare and Medicaid requirements. Proposals must demonstrate relevant organizational experience, staffing and key personnel, technology and reporting capabilities, quality control, financial capacity, references, domestic operations, and required certifications. The contract is for three years with two optional one-year renewals and is expected to begin July 1, 2027, or upon Office of the State Comptroller approval, whichever is later.
Classification Codes
Smart Codes
Specifications
Timeline
Requirements
- Commercial General Liability — $5,000,000.00
- Employee Dishonesty — $1,000,000.00
- Commercial Business Automobile Liability — $1,000,000.00
- Errors and Omissions Liability — $5,000,000.00
- Cyber Liability — $10,000,000.00
- Workers' Compensation
- Disability Benefits
- Minimum 3 references
- Within the last 3 years
- Client point of contact required for each reference
Documents
| Title | Date Posted |
|---|---|
| RFP# OMIG 26-23 (HHC MMX) - (final) .docx | - |
| rfp101626y | Oct 16, 2026 12:42 PM |
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